Frequently Asked Questions

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FAQ

Top Questions


What is a Medically Unlikely Edit?
A MUE (Medically Unlikely Edit) is a unit of service (UOS) edit for a Healthcare Common Procedure Co... (more)

How does Medicare pay for services delivered by non-participating providers?
... (more)

What is the column 1/column 2 correct coding edit table?
The column 1/column 2 correct coding edit table contains two types of code pair edits. One type cont... (more)

Who can enter medication orders in order to meet the measure for the computerized provider order entry (CPO...
As mentioned in 80 FR 62798, a medical s... (more)

How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit ...
For Medically Unlikely Edits (MUEs) that are adjudicated as claim line edits, each line of a claim i... (more)

Who pays the difference between what the provider charges and Medicare pays?
The provider has an ... (more)

What physician shared patient data sets are available?
The physician referral data linked below was provided as a response to a Freedom of Information Act (FOIA) request. The... (more)

What is the difference between a legacy provider identifier (LPI) and a National Provider Identifier (NPI)?...
LPIs are any of a kn... (more)

How are claims adjudicated with Medically Unlikely Edits (MUEs)?
Medically Unlikely Edits (MUEs) are either claim line edits or date of service (DOS) edits. If the MUE is a claim line e... (more)

How do I obtain the National Correct Coding Initiative (NCCI) Policy Manual?
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services may be obtained th... (more)

What is a Qualified Clinical Data Registry (QCDR) in the 2016 Physician Quality Reporting System (PQRS)?
A qualified clini... (more)

How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit ...
For Medically Unlikely Edits (MUEs) that are adjudicated as claim line edits, ea... (more)

How do I change the laboratory director's name on my CLIA certificate of waiver?
You must notify the appropriate State Agency within 30 days about the change in the name of the director for your CLIA c... (more)

How should modifier 59 be reported under the National Correct Coding Initiative (NCCI) program?
Modifier 59 is used to indicate a "distinct procedural service". (See Modifier 59 article at ... (more)

The billing provider on a claim is an eligible professional (EP) but the performing provider type is not an...
In establishing an encounter for purposes of patient volume, please see the regulations at 495.306(e... (more)

What does "column 2" mean in the column 1/column 2 correct coding edits table?
If the two codes of a National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edit pa... (more)

Do Current Procedural Terminology (CPT) codes for psychological and neuropsychological tests include tests ...
Yes. Effective Janu... (more)

What modifiers are allowed with the National Correct Coding Initiative (NCCI) procedure to procedure (PTP) ...
The following modifiers are allowed with the National Correct Coding Initiative (NCCI) procedure to ... (more)

How do I obtain a copy of my CLIA certificate?
To obtain a copy of your CLIA certificate, you should contact the appropriate State Agency. State Agency contact informa... (more)

I entered numerator and denominator information during my Medicare Electronic Health Record (EHR) Incentive...
CMS does not plan to conduct an audit to find providers who relied on flawed software for their atte... (more)

Which patients should be included in the denominators calculated under the Observation Services Method and ...
For the Observation Services method denominator includes patients admitted to the inpatient department (Place of Service... (more)

Is the physician the only person who can enter information in the electronic health record (EHR) in order t...
The Stage 3 Final Rule for the Medicaid EHR incentive progra... (more)

When I try to login, I get the error message stating, "Your account has been locked. Please try again later...
After three unsuccessful attempts to ... (more)

Is there an appeal process for units of service (UOS) denied based on Medically Unlikely Edits (MUEs)?
Units of service (UOS) denied due to a Medically Unlikely Edit (MUE), whether a claim line MUE or da... (more)

What are the supervision requirements for diagnostic psychological and neuropsychological tests?
Under the diagnostic test provision as a... (more)

What steps does a provider have to take to determine if there is a specialized registry available for them,...
The eligible professional (EP) is not required to make an ex... (more)

Are payments provided to a consulting firm or third party, whom in turn provide the payment (in whole or pa...
Yes, Open Payments requires reporting of both direct and indirect payments and other transfers of value provided by an a... (more)

What's the difference between the Outpatient Code Editor (OCE) edits and the National Correct Coding Initia...
The Outpatient Code Editor (OCE) is utilized to edit outpatient prospective payment system hospital ... (more)

Who are the current Medicare Administrative Contractors (MACs) for each Jurisdiction?
To find the current MACs and their contact information visit the CMS.gov website at: ... (more)

What is the value-based payment modifier (Value Modifier) and who does it apply to?
The Affordable Care Act requires Medicare to establish a Value Modifier that provides for differenti... (more)

When eligible professionals work at more than one clinical site of practice, are they required to use data ...
CMS considers these two separate, but related issues. Meaningful use: Any eligible professional demo... (more)

In calculating the meaningful use objectives and measures for View, Download and Transmit, Secure Electroni...
The transitive effect applies to the View, Download and Tran... (more)

If I am only drawing blood, centrifuging the blood and sending the blood to a CLIA certified laborator...
No, you do not need a CLIA certificate if the facility only collects specimens and performs no testing.... (more)

Are expenses for diagnostic psychological and neuropsychological tests subject to the payment limitation fo...
In most cases, expenses for diagnostic p... (more)

What is waived testing?
By CLIA law, waived tests are those tests that are determined by CDC or FDA to be so simple that there is little risk... (more)

What is the policy for measure calculation for actions outside of the EHR reporting period for the Medicar...
... (more)

Can more than one CPT code for psychological or neuropsychological testing be billed on the same date of se...
Yes. If several different, clinically a... (more)

What exactly does "column 1" mean in the column 1/column 2 correct coding edits table?
If the two codes of a National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edit pa... (more)

What is the CMS Medically Unlikely Edit (MUE) program?
The CMS Medically Unlikely Edit (MUE) program was developed to reduce the paid claims error rate for... (more)